PracticeUpdate: Dermatology - Winter 2018

EDITOR’S PICKS 7

Clinical Distinctions Between Neuropathic and Inflammatory Pruritus

Journal of the American Academy of Dermatology Take-home message

• The authors of this cross-sectional study of data of 267 adults with pruritus collected from two institutions between 2015 and 2017 investigated the clinical differences between chronic neuropathic and inflam- matory pruritus. Inflammatory pruritus was defined as pruritus resulting from atopic dermatitis or psoriasis. Neuropathic pruritus was defined as pruritus resulting from bra- chioradial pruritus, nostalgia paresthetica, unspecific neuropathic itch, or post-herpetic neuralgia. • Individuals with neuropathic pruritus were older than individuals with inflammatory pruritus (63.0 years vs 48.8 years; P < .001). Compared with individuals with neuropathic pruritus, individuals with inflammatory pru- ritus were also more likely to report their itch being associated with nociceptive symp- toms related to stinging, burning, sunburn, and pain. Jeffrey F. Scott MD Abstract Chronic pruritus has been grouped according to inflam- matory, neuropathic, psychogenic, or systemic origins. Among those with chronic pruritus, between 8% and 15% are classified as suffering from neuropathic itch. Neuropathic itch is a debilitating form of chronic pru- ritus that occurs secondary to damage to afferent itch pathways. The clinical characteristics of neuropathic itch have been suggested to include nociceptive symp- toms, such as burning, tingling, and stinging. Conversely, inflammatory itch is usually not characterized with other nociceptive complaints. However, a recent large study in patients with atopic dermatitis suggests that there may be an association with pain. Distinctions between neuropathic and inflammatory pruritus help guide the diagnostic workup and the selection of the most effica- cious classes of medication. Nociceptive characteristics of neuropathic and inflammatory itch have not been well studied. The purpose of this study was to examine differences in nociceptive characteristics between neu- ropathic and inflammatory itch. We used cross-sectional survey data collected A Cross-Sectional Study of Clinical Distinctions Between Neuropathic and Inflammatory Pruritus. J Am Acad Dermatol 2018 Jun 01;[EPub Ahead of Print], JD Rosen, AC Fostini, YH Chan, et al. www.practiceupdate.com/c/69432

Abstract Patient expectations shape the patient's attitude towards the consultation and the treatment, and are determinants of patient satisfaction. The aim of this study was to investigate the expectations of dermatological patients concerning the doctor, the consultation and the treatment, and to identify factors associated with patient satis- faction in an outpatient setting. Patient Expectations and Determinants of Patient Satisfaction in a Dermatology Out- patient Clinic. J Eur Acad Dermatol Venereol 2018 Jun 19;[EPub Ahead of Print], MB Søndergaard, MN Ghazanfar, SF Thomsen. www.practiceupdate.com/c/70008

• Tim Johnson, MD, also at the University of Michigan, taught and modeled the importance of treating every patient as if he or she were your family member. It's a simple thing, although not always easy; but I find it makes for improved satisfaction in my day. We all recognize that some patients or problems are not as easy to address as others, but my line to our team is that "everyone can love the puppy dog" – meaning that it's easy to give love and care to the cute kid or funny kind elderly patient, but smiling and giving that same care to someone who is not so "cute" is the mark of a professional and part of our job. • Meeting expectations from the start to finish of the patient encounter is key. This study looked mostly at the clinician encounter, but I believe the process works best if you recognize that this is a team effort. I tell my staff that everyone has the option to “pull the emergency brake” if they see that a patient does not understand what is going on (eg, needs to have the diagnosis or treatment information repeated). It is always best to avoid a phone call back to the office when the patient arrives home. I know that many clinicians have a policy of treating just a limited number of problems at each visit. While I recognize the need to move patients efficiently in and out and know that there are some patients/problems requiring rescheduling for another visit, I would rather deal with as many of a person’s concerns as possible at the time that that person is with me. Rescheduling for something that I can address fairly quickly while we are together seems much less efficient and takes away from another patient who has not been able to schedule a convenient appointment in a reasonable amount of time. Let me close by assuring everyone who has read this far that I do not meet the expectations of every patient, but I try and try to improve the process on a regular basis.

VOL. 2 • NO. 3 • 2018